Episode 490: How to Merge Patients (and Culture) Successfully

Question: Buying charts from another dentist? Here’s what you need to know.

The Dental A-Team is joined by Dr. Nate Tilman! Fascinating history aside (read his bio below), Dr. Tilman talks with Kiera about his unique dental practice situation, how he’s managed to merge five different practices into his own, and a strategy for doing so.

He also speaks to the shifting of culture in his practice, what it took for him to recognize, and the success it’s brought.

More on Dr. Tilman:

Originally from Salisbury, Maryland, Dr. Tilman attended Wake Forest University for his undergraduate degree. He was awarded his Doctor of Dental Surgery from the University of Maryland where he graduated Summa Cum Laude in 2001. Dr. Tilman served in the U.S. Navy Dental Corps for four years, including two years forward deployed aboard USS Ashland (LSD 48).

Following his military service, Dr. Tilman moved to Newport, Rhode Island, in 2007 and opened Newport Family and Cosmetic Dentistry. He has had the pleasure to work with an amazing team and amazing patients in creating a state-of-the art, caring, and comfortable dental practice. His commitment to incorporating advanced technologies and techniques allows Dr. Tilman and his team to provide dental treatment in fewer visits and more comfortably than with traditional techniques.

Episode resources:

Check out Dr. Tilman’s Rhode Island practice

Reach out to Kiera

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Transcript:

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0:00:05.6 Kiera Dent: Hey everyone, welcome to the Dental A Team Podcast. I'm your host, Kiera Dent, and I had this crazy idea that maybe I could combine a doctor and a team member's perspective, because let's face it, dentistry can be a challenging profession with those two perspectives. I've been a dental assistant, treatment coordinator, scheduler, filler, office manager, regional manager, practice owner, and I have a team of traveling consultants, where we have traveled to over 165 different offices, coaching teams. Yep, we don't just understand you; we are you. Our mission is to positively impact the world of dental, and I believe that this podcast is the greatest way I can help elevate teams, grow VIP experiences, reduce stress, and create A Teams. Welcome to the Dental A Team Podcast.

[music]

0:00:49.4 KD: Hello, Dental A Team listeners, this is Kiera and you guys, I love podcasts where I get to bring on offices that I just think are fantastic, so this is an office that we have worked with in the Dental A Team. Also fun fact, he is in the smallest state in the entire United States. So you all know me and my state traveling, his state is one of my hardest states to get to every year, 'cause it's so tiny, and it's so far away from me. But he's just one of the best people I've ever met. He's an incredible leader, incredible dentist, incredible just good human. So I'm so glad and so excited to welcome Dr. Nate Tilman to the show. How are you today, Nate?

0:01:27.7 Dr. Nate Tilman: I am great, thank you, thank you. I'm super excited to be here. As you know I've been a fan of the podcast for... Pretty much since you started.

0:01:36.4 KD: Thank you.

0:01:38.5 DT: And it's kind of surreal being on the podcast, so I appreciate the offer, thank you for this.

0:01:44.6 KD: Totally. Well. I love it, I love to... One, it's fun. Thank you for being a podcast fan, I mean, it's almost coming up on three years of the podcast since we created it, and I never would have thought that the podcast could connect me with such cool people, so... One, thank you for being a podcast listener and two, thanks for just being a rad person. I liked... The podcast has being a fun passion project for me to meet people, to hear their stories, so I kind of alluded to it, you're also doing something similar to Dr. Dave Moghadam, who was on the podcast about those chart mergers and buyouts, that's kind of helped with your growth, but kind of just tell the listeners how you even got into dentistry and kinda what your growth trajectory has been, just so they kind of know as a background to today's podcast.

0:02:28.8 DT: Sure, yeah, I'll try not to ramble too much about it, but... Yeah, I went to... Always wanted to do something in healthcare. My grandfather was a public health physician, was a big inspiration for me. So I think it was midway through college, I decided dentistry is gonna be a really good fit, for a number of reasons. Went to University of Maryland for dental school, loved it, decided to stay in general dentistry for all the variety of what we do. I was on a navy scholarship, so I was able to spend the first four years as a practicing dentist in the Navy. Two years I was on a ship as the only dentist, so those are really good... Didn't realize how helpful an experience that was for running an organization, even though it's an organization of three...

0:03:14.6 KD: Yeah, but I also feel like, let's just talk about the Navy real fast 'cause I didn't know this about you and my husband and I were literally talking probably two days ago, and he said, I don't think I ever could do the Navy, put me on a ship with these people for so long and dump me in the middle of the ocean, like nowhere to go, no hiking. What do you even do? How was that? I feel like, more than anything, it would teach you mental stamina, is what I think I would learn from being on the Navy. How was it for you? Maybe you guys go swimming every day, I don't know. What do you do all day?

0:03:44.1 DT: Definitely not at all. So it was... The tears on the ship was very... It's a super unique experience, and we were a small ship, 400 sailors, we transport a Marine. So I was responsible for pretty much 400 patients. It was me, I had an administrative assistant and I had two dental technicians that could do some basic hygiene, not a hygienist, but it was me. So having to learn managing supplies and managing appointments and all of that stuff, but the unique thing as a dentist... This is one year out of my GPR, so still I was safe, but didn't really know necessarily all what I was doing, but I [0:04:28.7] ____ get myself out of jams because middle of the ocean, mid-procedure, I'm not gonna be the guy calling a helicopter, [0:04:36.3] ____ let me know, so you gotta work right through it.

0:04:41.3 KD: That would be terrifying though, awesome 'cause it's gonna push your limits and you've gotta just figure it out, which I think so many dentists when they do own, they don't learn that stamina, that stress like, Hey, it's you, figure it out, but you're like... The odds are even stacked more, you're in the middle of the ocean, and it would have been a pretty cool story for me, maybe not for you to hear a helicopter had to come get a patient, 'cause you botched their root canal or something. You'd have to figure that out, but that does definitely up your odds of intensity for sure being out there and nobody else is there to help you. You're the man. You gotta figure it all out.

0:05:13.1 DT: Yeah, and I think it's... While it would have been nice to... If I've had a situation where I had a mentor or another dentist I was working with, to be able to bail out, it would have been helpful, but it really... It did, it gave me a lot of confidence early on, felt like I can work my way through this, and then also what things I don't wanna do 'cause I don't wanna get stuck in that position again.

0:05:35.8 KD: That's true. So true.

0:05:37.2 DT: And yeah, while I didn't have to helicopter anybody out, one of the things I did do, and I don't think at the time, nobody had ever really done it from a small ship or the even smaller ships around us that there were two times where people had some dental emergencies that I was able to fly out to those ship and take care of them and come back.

0:05:53.4 KD: No way. Well, you do have built-in planes, you can travel anywhere, so it's like quick, like fly you in, but that's crazy. I can't even imagine the stress that those poor other dentists were feeling of... We're in the middle of here. What am I supposed to do? I guess, call someone else like... [laughter] We talk about dentistry... And I've said this so many times, I feel like dental practices are like these solo islands out there, all y'all just kinda hang in your own area, you literally were in the middle of the ocean flying solo.

0:06:23.3 DT: Yeah Yeah.

0:06:23.2 KD: That's Crazy.

0:06:23.3 DT: So it looks like there wasn't a ton of dentistry dude, so a cool thing in the navy, they give you other jobs. So I became an air traffic controller, so I was in charge of all of the plane operations on the ship. So between that and dentistry, it kept me pretty busy... And then I played a lot of video games.

0:06:42.3 KD: I was wondering I would be pulling pranks. I mean, just throughout covid, my husband, he makes fun of me. I feel like a roaming tiger in these four walls of our house. Sometimes I'm like, "Just let me outta here!". I can't even handle... I'm like I gotta go for a run, I gotta go for a hike, that I can't even imagine being on a ship. I would be like, I know I'd be pulling pranks on every single person on that ship and just running for my life, 'cause I probably would torment everybody. But air traffic control, that you really went for all the things, dentistry and air traffic controller, Don't they say those are the top two suicide jobs? You really went through the whole extreme there, nice job!

0:07:15.4 DT: Well, that's why. When they selected me to go to the school for air traffic controller, I was like What are you guys trying to tell me? You already know I'm a dentist.

[chuckle]

0:07:24.2 KD: Gosh, that's crazy. So you were in the Navy, and then you went got out of the Navy. Did you go straight to private practice? Did you go and be an associate...

0:07:32.7 DT: Yes, so I was an associate for a year, still in the Virginia beach area. And then moved to... We moved Rhode Island. My wife is... We met in college, I'm two years older. She was awesome for following me around. And then... So when she was done with her residency, she's from New England. That's what we looked up here. And I'll tell you, Virginia beach area is super easy to get a job as an associate... Tons of positions around, I figured it'd be the same thing. Coming up here, and there was nothing. It's all...

0:08:01.5 KD: Nate, Rhode Island is the size of a dot on a map. I mean, it's itty bitty [chuckle]

0:08:05.6 DT: And there's not...

0:08:07.2 KD: Which I think makes you a celebrity, just because you live there. Not many people even live there.

0:08:11.2 DT: Yeah, there's a number of dentists, but it's all solo guys and it's tough, like restricted covenants. You get a two-mile radius, that's the whole state.

0:08:20.9 KD: Exactly, exactly, that is...

0:08:22.8 DT: It was incredibly hard.

0:08:27.4 KD: You definitely have to look at your associateships of their contracts really closely. Otherwise you might be booting booted out of that state, just because like you said, two miles radius is not far in Rhode Island.

0:08:33.6 DT: It's not, not at all. So I ended up having an opportunity to buy a small, it's like a phorapotory practice. I think two and a half, three days a week, the dentist definitely on the decline of a practice. So jumped into that, I had no idea what I was doing, and then six months later was approached by another dentist who was moving from the area. I think it was a family thing too, and he was having trouble getting somebody to buy his practice. Rhode Island not many dentists moved to here to the state for a number of reasons. Again, I was still trying to figure out how I was paying my initial loan and how I was running this practice or whatever. I was like this is the opportunity to buy... To merge the patient base. So I did that and it was definitely the best thing I did. 'Cause it brought in a whole new group of patients. I was able to go from two and a half days a week to four days a week. And then I was able to add another hygienist at the time. It wasn't super intentional, but the growth was happening, it's just kind of fell in my lap, like, "I'll do this." And looking back, it is where I realized what a good thing it was.

0:09:48.8 KD: For sure, and I hope people listening... I am a firm believer that opportunity doesn't always knock on the door and say: "Hey, I'm opportunity". Sometimes it looks like pure chaos, sometimes it's stretching you beyond, sometimes it's really just showing up. I remember the day that I was asked to work with DSI as a consultant. Guys I had one consulting client before Mark asked me to be a consultant. And overnight, I had 45 clients in my lap. I don't know what the heck I was doing, but I hope people listening realize. For you, you're struggling, you just buy your practice. I don't know what you're doing yet, you've had quite a bit of experience. But at the same time, running a practice is very different than being an associate, or I'm sure even in the Navy. And so now. And then oh hey By the way, there's all this other patient base wanting to come in. And I love that you just... You jumped, you took that opportunity. And I think again, so many times in life opportunities show up, it's just a matter of are we willing to take them and figure it out, or are we too scared and just let them pass by?

0:10:50.1 KD: You brought those patients in and you were mentioning pre-record that adding in patients from other practices has really been a great way for you to get new patients. People are constantly looking for new patients. I was just talking to... There's a guy out here, he's a podiatrist. Guys I'm like, I don't know, I just can't help myself but help business owners. I love it, podiatry is not that much different than dentistry. Y'all see patients, dentistry will work on the mouth, podiatry work on the foot. Basically It's kind of like pediatric, you go to your surgery centers, they come in, you see these patients for their adjustments. But I was talking to him and he's a solo podiatrist and there are two podiatry offices around him that had just shut down doors. So he was like, yeah, it's just great, people are finding us.

0:12:00.5 KD: And I'm like, did you call those people and ask them for their charts? Buy those charts... That is two practices worth of patients, that you're just hoping maybe one day will Google you when they're seriously sitting right in front of you. So I'm super curious, I love this topic, I know Dave's talked about it as well. But Nate how do you buy chart successfully? How do you make that transition? Like Dave was talking about buying so many charts, but kinda from your experience, how do you buy these charts, how do you merge these patients in successfully? And other than just good luck and being in the right place at the right time, finding more of these opportunities... I'm super curious.

0:12:04.7 DT: Yeah, yeah. So for this one, having no idea what I was doing. I did have some, I think, good advice from a transition attorney that I worked with. But initially, the guy that was selling his charts, he wanted X number of dollars for his... I think he said 1000 active records.

0:12:25.9 KD: Okay. And what's like X number of dollars? Just give me a ballpark, you don't have to say the exact amount. Is it $5 a chart, $10 a chart, $30 a chart? Like what is...

0:12:35.9 DT: If I remember, and this was probably 10 years ago. So I believe it was $60 a chart is what he wanted... So he wanted 60 grands. Again, I didn't. Not knowing too much, I definitely knew that there was 1000 people were not gonna come over. So I was worried about, what's the risk? Are 10 people gonna come or are 800 gonna come... I have no idea.

0:13:00.5 KD: Yeah.

0:13:00.5 DT: Yeah, so the attorney I was talking to is... He said he'd never done it this way and said, but maybe what you wanna do is offer a little bit more per record, but only for a small percentage at first and then keep track of it over time. But that's what I think I did. It was either 100 or 120 a chart, and I prepaid for 300.

0:13:19.6 KD: Got it.

0:13:21.0 DT: But then for the next year, I kept track of all the... Once I got above that 300, I kept track of it. So the nice thing is it limited my... It limited my risk, it put more, I guess, importance for motivation on the seller to really push his patients to come. There's a more... Or he would make more of the more people that came to see me. So it was win-win that way. And it also... It let me kind of control that the influx too... Because I think if all of a sudden I was getting 800 patients calling all at once it would be a little bit trickier to kinda [0:13:56.4] ____ all by himself. So that worked out really well.

0:14:00.2 KD: And I'm just curious on that, 'cause this is something else I've been really wondering after talking with Dave, now I was meeting this podiatrist because I just... I love this type of stuff, this is cool business stuff that I feel a lot of people don't talk about, so I'm curious, how long was the arrangement? Was it like for a year that you would pay him? . Was it for five years you'd pay the selling doctor?

0:14:19.7 DT: Yeah.

0:14:20.0 KD: Because I'm curious like, how was the motivation and for me as a business owner, I wouldn't want this to go on forever. I'd want like an end date when I don't have to pay you 120 dollars per patient. How is that kind of arrangement set up?

0:14:33.4 DT: Actually, it was nine months is what we had set, and I think it could work either, but I certainly wouldn't go more than a year 'cause it is... It becomes a major pain. And then honestly for me, as I got close to that nine months, we sort of started slowing down, we strategically scheduled those last few patients in the nine months, but I still had all the records, so...

0:14:54.9 KD: That's... I was am curious, did you get all the records? So you pay this, all the charts come to you and then other dentist has good faith that you're gonna be honest?

0:15:02.6 DT: Yeah.

0:15:02.8 KD: Or do they get access to it? Was that what it was?

0:15:05.1 DT: He could have like... We had it written, if you wanted to send somebody in to audit it. Absolutely, he had access to do that, he just never did.

0:15:11.4 KD: Sure.

0:15:12.4 DT: And we had an initial wave of a lot of people, and then it slowed down a bit and it's a... I think, I think it ended up... Maybe we got 450 out of that thousand.

0:15:26.7 KD: It's pretty good.

0:15:28.1 DT: And it was close to that nine months, we were getting close to 400, and again, I just... We slowed down a little bit.

0:15:35.8 KD: Sure.

0:15:36.7 DT: Just to whatever. And then, but I... As soon as that nine months hit then we started re-marketing to the people we hadn't seen yet.

0:15:44.3 KD: 100%, 'cause then it's like you've got basically 400 patients on recall.

0:15:47.8 DT: Yeah.

0:15:48.0 KD: That haven't been in and so did you guys win? It happened, and of course, you might say things you'd do differently or whatnot, but did you have that selling doctor send a letter to all of his patients like, Hey, I'm no longer seeing you, come see Nate, he's fantastic. Or did you guys just pick up the phone and start calling these people, what was kind of the strategy of the how-to for you.

0:16:07.0 DT: Yes. So he... We both were a joint letter.

0:16:10.3 KD: Okay.

0:16:11.3 DT: Which was good, and then I was able... I actually brought on his... He didn't have an office manager, but it was like his lead front desk and scheduler.

0:16:20.3 KD: Smart.

0:16:20.3 DT: So we brought her on, she wasn't a great perfect culture fit, but she knew the patients.

0:16:26.7 KD: Exactly.

0:16:32.4 DT: And that worked. I think she was with us for probably about the nine months.

0:16:33.1 KD: Because in my mind, I was thinking like, oh, that's genius, maybe you can do a little sweetheart deal where it's like, hey, I'm buying your charts and also your scheduler upfront. Can I just have them help me call these patients, I'll pay 'em for a couple of months or what not. I don't know, there's a piece of me that's like I could see the pros and the cons of that, but you're right.

0:16:48.4 DT: Yeah.

0:16:49.2 KD: It's me calling that person who's known these patients for years, calling to get them scheduled and help out with that, that's probably... Again, even if it wasn't a great culture fit, it probably did get more patients in your door.

0:17:00.8 DT: For that initial... Yeah, absolutely, for the initial, 'cause they already have the patients pre-scheduled, so they were able... And they know 'em. That it was really helpful having that familiar voice.

0:17:09.4 KD: Totally.

0:17:10.7 DT: Yeah.

0:17:10.7 KD: Clever. Okay, so you went higher than what they're doing, which I tell everybody, I'm like, these people who are shutting their doors, pretty much any offer you give them is, don't be like a low ball and completely have it looked through, because they have no option to sell... There are no options for them to sell, they're not going to make any money, that's gotta be a hard reality for that selling doctor to realise like, hey, I built this business up, but it's not even a sellable product, so I have no asset anymore. So I'm like, honestly, any money that they can get for these charts, I do think is a good deal and something great for the selling doctor as well, so I don't think it's a vicious... Like you're taking advantage. I just think, again, opportunity shows up in different ways, and I think for the selling doctor, it also was an opportunity that they got probably way more than they were expecting to get when they closed the doors of their practice.

0:18:02.3 DT: Yeah, 'cause honestly, if it hadn't been... Panuki group then trying actively to sell it somewhere, and I was like, I think I was the last person and also had not been able to step up and work something out, it would have just been all these patients out into the ether and probably who knows how many of those 450 would have shown up with us anyway.

0:18:21.8 KD: Sure, yeah.

0:18:24.0 DT: And it's, again, being younger and not knowing what I was doing, that was intimidating for me, but as I look back like, he'd never done that either, so it was all new for both of us.

0:18:33.2 KD: Well, l was also thinking about... I'm sure some listeners might think like Nate, that's a bad deal though, spending 120 per patient chart, and if you are a wise business owner and you know the cost of acquisition of a new patient. Yes, I would say that that probably is on the higher end of a patient. However, I think the perk of this is these are most likely patients who have been active patients in a dental practice that are going to be good patients that are coming in and odds are... They also might be, I call them sleeping patients, in the fact that this dentist was on the retiring side, odds are that dentist was just slowing down with dentistry every day, this will have this happen to where odds are these patients actually have a lot more treatment available since their selling doctor was slowing down in their career. So while it might be more expensive, you're probably also paying for it with the dentistry available with an older doctor selling, so...

0:19:22.5 DT: Absolutely, yeah.

0:19:24.0 KD: Got it, okay.

0:19:24.7 DT: Yeah and then, yeah, and then fast forward another five years or so, from then it's not five, about five years ago.

0:19:33.0 DT: I had a dentist moonlighting with me, who was in the Navy, he was getting out, wanted to stay in the area. Awesome, awesome dentist, really good friend of mine now, and he... He wanted to stay but again, at that point, I wasn't busy enough to really support another... An associate and I had never really... Never had an associate either, and again, opportunity I had... I was having... There was a County Dental Society meeting, I was talking to a friend of mine as well, who was a little bit older dentist, and she's like, "Oh, I'm thinking about slowing down, so maybe this guy could work for you for a couple of days a week, and me a couple of days a week," and a light bulb went off in my head. I was like, "Or I could buy your practice if you're open to it," and then you can slow down whatever you want, be an associate with me and he could work at the two. I kinda saw the writing... The potential, if he did that, what happens if now he wants to buy that practice and then it's... So that actually worked out great.

0:20:30.5 KD: You would be training up your competition, so good job on seeing that and not letting that happen.

0:20:35.8 DT: Yeah, and that worked out great, around... Again, just weird timing around the same as I was closing on that deal, one town over there was a dentist who unfortunately had terminal cancer, and was looking for somebody to help take over his practice, so I was able to take over his patient base which another bonus of being able to help get this new associate even busier.

0:21:01.0 KD: Totally. So really, your practice is a make up of four practices, did I count...

0:21:06.4 DT: And I had one more a little bit later...

0:21:08.2 KD: Okay. So five. [laughter]

0:21:08.6 DT: It was like five... Five combined into two locations now. So...

0:21:12.9 KD: Clever.

0:21:14.2 DT: Yeah.

0:21:14.7 KD: I Love it!

0:21:15.4 DT: And... Yeah, and with that one, I was... I was able to bring one of the hygienists onboard, which again, that familiar face, familiar voice was a big... Was big... And she's still with us and she's awesome.

0:21:28.9 KD: Awesome.

0:21:30.0 DT: So that's been really good.

0:21:33.2 KD: Have you guys heard? But really, have you heard? And are you the type of person that loves to take massive action? Well, if you are, I would love to invite you to Dental A Team's virtual summit, April 22nd through 23rd. And yes, right now, guys, it's early bird, that means it's $200 off the normal ticket price. You guys are going to learn how to optimize your practice this year. We know it's been a rough year, people have quit, we've had COVID, we've had changes, so we wanna teach you guys how to optimize within your practice now and execute. Friday is full team, Saturday is all things leadership, so bring your team, get some CE, take massive action, head on over to thedentalateam.com, coupon code is summitearlybird, and it's valid until March 31st, that's summitearlybird, all one word, and is valid until March 31st. So guys, head on over, I can't wait to have you take massive action, optimize your practice and execute. Let's make 2022 your best year.

0:22:30.9 KD: I love it, I love how much you have... I think if... If anything I'm taking is, don't be afraid to take those risks, don't be afraid to look at opportunities, and also, I think you just kind of have also positioned yourself to be well-known within your community, and I feel like so many dentists like... Yes, even within big cities like New York, Denver, guess what? People are always retiring. I just had a student from Midwestern reach out me, and was mentioning how like... "Hey Keira, do you know of anybody to buy a practice?" And I'm like, "What is going on?" I don't know all the details, but I'm like, this is somebody who's been graduated for maybe a couple of years, looking to sell a practice, and so I think it's just important to get to know the doctors around you, to build those friendships because, when... I think it's often like you're putting yourself in a position to be ready for that opportunity.

0:23:19.5 KD: It's kind of like right now, they say "have a lot of cash on hand", we know something is gonna be shifting in the economy, so just be ready for when opportunity's there and I think getting to know your neighbors, getting to know those dentists, hey, great, you also, as a dentist, might need them as a resource in the future as well, so I think it can go both ways. But I love that you've done that. So now I'm curious Nate... Because I selfishly wanna talk to you about this, you got these two practices, you've got these dentists. Who knows, you're gonna probably add on like four more practices of charts in the next five years based on your record, let's just start piling them all on, you'll be the only dentist in Rhode Island.

[laughter]

0:23:54.4 KD: You're just going to outlast them all. [laughter] But I know culture is something you and I... Off air, Nate is one of my favorite clients. I don't even come to your practice Nate, and you and I will just chat business, talk shop, you are somebody that I will say publicly is someone who's just been, a really great influence in my life. Periodically, you will just send me a random text of, just tell me that we're doing a good thing, and I will say... And you know, as an owner, those kudos and those good vibes, they don't happen as often because you're the one who's giving all that out to your team, and to your clients, and to your patients. And so Nate I will say publicly how much you've just been an influence in my life as well, something I just have appreciated with you as a client, as a friend, as a mentor, so I'm excited to chat, you got all these things going... I know culture has been a piece that you and I both have been talking about, of developing this culture. So kind of what spurred you into realizing you wanted to shift your culture of your practice, and then let's talk about the nitty-gritty, but how did you as a business owner know you needed to do a shift within your culture, 'cause I think that that's humility, and I'm just curious, what tipped you off, how are you able as a dentist to own that, that you wanted to shift that?

0:25:03.9 DT: Yeah, I think for me it was noticing the patterns over the years of... Just the ups and downs of culture, and it's... Whether you call it the vibe or how everybody's getting along, and it's... Over the years, we've had some pretty painful... Painful times and times where it's like, nobody likes being here, that's way better in the last few years than it had been in the past, but it's... And I was realizing, I didn't really know how to...

0:25:36.9 DT: I didn't realize that I could have influence on how to change that. Some of it, I'm not a confrontational person, I'm pretty laid back, and I wanna be the one that's liked, I wanna be everybody's friend. And it's hard, whatever, 13 years into practice ownership and I still struggle with that, kind of not being able to be everybody's best friend. I actually am the boss, and I have to own that.

0:26:10.1 KD: Yeah.

0:26:10.6 DT: So, again, I finally just really got so exhausting of the ups and downs of, Is this gonna be a good month, or is this gonna be a good week, or who's gonna be upset? And all that. So that it's not just on me, but it's creating that environment that people wanna be here. People are happy, people are playing well together, and trying to manage all that. And I certainly haven't figured it out completely, but it's just trying to work on little things.

0:26:41.4 KD: Yeah. Well, and I love that you say that, because instantly I'm like, Oh, Nate, why didn't I even think about this? I know why you and I are good friends, we're I's on the DISC profile. We both love to be liked, we're both very outgoing, we're like life of the party, have a good time, but we're also okay to let other people be the life of the party. But just really that... And I do think a lot of dentists have that personality. I was thinking about dentists last night actually while I was falling asleep, and I'm like, Gosh, you guys have to charm and dazzle and wow all day long. You walk in and you have to make friends quickly, and it's in an uncomfortable like, Hey, let me get real up and close and personal like look in your mouth, and I gotta win you over and make you like me and wanna say yes to treatment. That's a lot of output of energy all day long for you guys. And so for you to realize that you also have to be a boss, I think one takes humility, and two, it also is ownership.

0:27:31.8 KD: And I would agree, I think it's like you get to a spot where I'm like, Alright, being friends is fun, but we gotta have this even keel, 'cause this up and down is just causing me to feel like I'm in whiplash all day long. So what were some of the things that you started to shift? Again, you and I chatted in December, and I know we both... I've taken this from our conversation of, culture is a slow burn. It is not something that happens overnight. It is not something that is instantaneous, and I am an instantaneous person. Like, I will figure it out, I will come up with it, we will find the solution, and culture is like, Alright, cool, I'm here for the journey. So what were some of the things you started to shift that you've been able to see? I know Tiffany has been helping you guys in your practice quite a bit as well, but I think ultimately at the end of the day, consultants can only help as far as the leaders are willing to go. And so for you to be willing to shift and change is why your team's been shifting and changing too. So what were some of those specifics?

0:28:27.0 DT: One of the, I would say the hardest thing for me, and it still gives me anxiety and trouble, is having difficult conversations. And while... You wouldn't think it would necessarily play toward helping with culture, you're having difficult conversations, I think it really does. Because I think it resets some of that... Like where the expectations are, what... Kind of the clarity on what needs to be done. And I think that's part of on my ups and downs, again with wanting to be agreeable and being pretty laid-back. If there was some trouble happening or there's some conflict between the team, like a lot of my default for years was, It'll just blow over, let's let it work itself out. And it would work itself out by exploding after a period of time, and then everybody would hug it out after a drink or two, and then we're fine for a while. But that was no way to operate, right? So for me, getting over my fear and my anxiety of having those hard conversations. And actually that's one of the things that Tiffany has been super helpful with, on helping me through some of those. And I think one of the biggest skills that I've gotten with working with the Dental A-team is that how to have those conversations.

0:29:53.5 DT: They're not fun. People don't like them, I don't like them, but I think it makes a big difference and means a lot once people... Once you get through that.

0:30:02.6 KD: For sure. And you're lucky to have Tiff. I think Tiff is one of the best at it. Tiffany is very masterful on being able to, I say word ninja it. She's also just very direct, which is odd because she's so lovable and so nice, but something her and I have chatted a lot, and to your exact point, when team members have those uncomfortable conversations and they know their employer's willing to do it, everybody actually feels safe.

0:30:29.4 DT: Right.

0:30:29.9 KD: And that safety can create stability, which also creates easiness. So my husband and I, felt like I used to be a people pleaser with him, and just this week he and I had a really big decision, a really awesome opportunity, and we ended up turning it down. And I was so frustrated, I'm such a driver and doer, and, This is an opportunity, we were working for five years for this and we're just gonna walk away from it. And I was not my most polished Kiera. Thankfully, I would never do this with my team, but my husband, I was just like full-on expressive on... And not anger at him, just the frustration of the situation, like, We've worked for this for five years and we're still not going to go through with it. And he made a comment to me, he said, "Kiera, I love that we've worked on our relationship so much, to where you can feel comfortable and confident to have this conversation, to express your true feelings, and we can work through it and find a solution."

0:31:24.2 KD: And I use that example 'cause I feel like it's very similar with teams with bosses that are willing to have these uncomfortable conversations, because there's a trust and a confidence that, I can come to you, I know we can go toe to toe, I know we can work through this, even though it's not fun in the moment per se, there's so much beauty and ease and flow that happens because we're not just always holding it inside, trying to charm everybody else around us.

0:31:48.1 DT: Yeah. And what I have sort of seen as I'm doing that more often and as I'm getting more comfortable with it, I'm seeing my team do the same thing with each other, in a respectful way, and they're confronting things before they become these underlying, deep-seated issues.

0:32:09.0 KD: Totally.

0:32:09.6 DT: So yeah, so that's been good. Working on gratitude is another big one.

0:32:14.2 KD: Yeah.

0:32:14.4 DT: Which it's funny, it's...

0:32:17.6 DT: That's taken me a little bit to get used to and coming up with a pattern of how to do it, because it doesn't necessarily come naturally to me. I think it all the time in my head, you know, how appreciative I am, but it's expressing it is what's hard, and finding the way that resonates, 'cause everybody's different, what lights everybody up is different. So I'm still trying to figure that out for everybody individually.

0:32:43.2 KD: But I think it's awesome that you're taking that on, and like you said... And I will say, kudos to male doctors that are willing to share their appreciation, because I'm not a male, but I have heard from several male colleagues that it's very uncomfortable. They're like, "I'm just not somebody... " Like you said, "I think it, but I don't necessarily say it and I don't know how to say it, and sometimes it's awkward thing." But I will say, as a team member, I worked only with male doctors, except for one time I had a female doctor, but most of the time, males were the doctors I would work with. And as a team member, especially a female team member, it meant the world to me when they would share that appreciation. And it just would... Most women are very much people who love those words of affirmation that are genuine and sincere. And so I think that that's a great thing that you've taken on, and I know that that's shifting, because you shifting that way is shifting your entire team as well.

0:33:32.7 DT: Yeah.

0:33:32.8 KD: Very cool. Okay, I just want like a quick highlight list as we wrap up, Nate. I appreciate you so much. What are some of the things working with Tiffany that you guys have implemented in your practice, or some things that you've seen? Like we've talked about chart mergers, which, gosh, is just so fun. And we talked about culture shifts. But what are some of the things over the last year... Yeah, you guys are just wrapping up, you're headed into year two.

0:33:51.8 DT: It's been a year. Yeah, yeah.

0:33:54.5 KD: Yeah, what are some of the things you guys have implemented with her this last year that were really just impactful for you?

0:34:00.9 DT: Yeah, we've done a bunch of small things. And that's what I think has been great, is they're easy concepts. But, communicating better hand-offs from front to back and committing to that. It's one of the first things that she introduced with us, and it seemed like such a simple thing, but it's made a huge difference in just having consistency of communication and then also it helps the teamwork. That's been really good. She's helped a lot with trying to have us have a better sense and strategy around our revenue cycle. Just little things that we didn't necessarily know that we weren't doing as efficiently as we could. But what I love the most is the process, and the accountability part that's put in there. In previous years, I've worked with other coaches and consultants and things, and it's always been a cookie cutter type thing. And it has been helpful, but what I really love about Dental A-team is how... She's able to look and see exactly what it is that we do and how we do it and tailor those systems to us. But also that holding us accountable to do it. We had a call this week I think it was, and we've been looking at outsourcing thing for...

0:35:29.4 DT: And I think we've probably been talking about it for a month. Two months or so. And it was kind of funny 'cause she's like the sweetest person in the world, but she was like, Alright, guys, I'm tired of talking about this.

[laughter]

0:35:40.2 DT: You're gonna by the end of... And we're gonna make a decision on this. In my head, this was on Tuesday, I was like, Alright, by the end of Thursday, we'll have this done. She's like, Today.

[laughter]

0:35:48.0 DT: You're gonna text me today that you've done this and tell me who you're going with. And I was like, Alright. But sometimes that's what we need, 'cause we were stuck in this little cycle.

0:35:56.9 KD: Sure.

0:36:00.5 DT: So she's good with that. And sort of same thing with the... One of the difficult kind of conversations I needed to have. But it was, Tuesday was funny, she was... She really lit a fire under us, there was like three or four things that like, You're getting this stuff done today, and it's happening.

0:36:14.5 KD: That's awesome.

0:36:15.6 DT: But that's the push we need, but it's not always that intense.

0:36:17.6 KD: Sure.

0:36:18.1 DT: There's also... If we need a little help with things, and it's a process, she's there each step of the way.

0:36:25.4 KD: That's awesome, I love it. Well, and I think that... Yeah.

0:36:27.6 DT: Oh sorry.

0:36:28.1 KD: No, no, go ahead.

0:36:28.4 DT: What's been really good, that I haven't seen with anybody else I worked with before, is she's totally accessible to my team. And I have a couple of the people on my team who are very growth mindset, growth-oriented with us, and I think they talk to her more than I realized, and it's one of the... I felt initially when she gave everybody her contact information, I was like, I don't know, I hope that doesn't get abused. And she's like, I love it, that's what I'm here for. And not knowing the specifics of what she's helping some people with, like I've had a couple of people on my team who are like, It is so great to be able to reach out to Tiffany and get this advice on this. And she's helping them just as much she's helping me.

0:37:08.9 KD: That's awesome.

0:37:11.7 DT: So good.

0:37:12.0 KD: That's huge. And I appreciate that, Nate, because, one, it's fun to hear how our consultants are doing, and I love a few pieces you said. Which makes me happy, 'cause as an owner, and I'm sure as a dentist, we have this great vision of what we want our company to be, what we want our practice to be, and then to hear a patient experience, to hear a client experience, I'm like, we will never be cookie-cutter; I refuse forever. Because no practice is cookie-cutter, so to hear that it's systems, that are customized to you guys where it's what's gonna work with you. And also, like you said, that accountability. Tiff and I... I will say kudos to Tiff, because at first we were like, Oh, how do you consult offices? And most of the time we'll just kinda go through with you, holding you accountable, but there are times when we will need to laser in, lay it down and be like, Guys, here's the reality. Just like a coach at the gym. I'm like, I don't want you like high-fiving me that that was a great workout when my squats looked terrible. Like tell me to get my booty down, get my back out, make sure I'm actually doing the work if I'm going to put in the work. And so I love that she did that, and like you said, that is something that we are so pro. Having those team members elevate, rising them around you, that's something we have kind of... I have a three-prong approach, and it's making sure you are profitable as a business, 'cause if we're not profitable...

0:38:22.8 KD: Fantastic. And to hear that Tiff is helping you guys with that revenue cycle, making sure it's there at the hand-offs. But then also growing people themselves. So you with those hard conversations, you making sure... We were just talking, you're having time off and your whole team is killing it and you're not even there, which is awesome. Also elevating team members, so it's not just the dentists themselves but the team. And then putting in those systems and team development, top to bottom. So to hear it from a client experience, and we didn't even rehearse this prior to it, but to really hear the... And I didn't even prep you, Nate. I didn't tell you to like, Hey, think of the last year and the highlights before we get on it. And I purposely did that 'cause I wanted to hear what really stood out to you over this last year, what were the things that... Because, sure, you could go back and re-read the emails and prep for it, but I'm like, that doesn't actually matter, what matters is what sticks in the moment. And so I just appreciate that.

0:39:11.0 KD: I love you as a client, I know Tiff loves you as a client. You're just a... You're a great example of execution, of humility, of seeing opportunities and executing on them, and I hope people realize that success, in my opinion, doesn't just happen by chance.

0:39:25.4 DT: Right.

0:39:26.8 KD: It is methodical, it is executed on. Sometimes you get sprinkled with that good luck charm, but I also think that good luck charm is only good luck if you actually execute on it. So Nate, you're just a dream, I love it, I love what you've done, I appreciate you being on the podcast. You're just such a happy human and you're a great person who's doing great things in this world, and your team's super lucky to get to work with you and learn from you as well.

0:39:48.7 DT: Thank you so much, and I feel so lucky to have come across the Dental A-team three years ago, and gotten to know you, gotten to know your team and all of you, to me, my team and my life. It's awesome.

0:40:00.9 KD: Totally. Well, we said yes 'cause you were in Rhode Island first, that was the first initial yes, and then, you know... But no, I appreciate it, Nate. So, guys, if you have questions on mergers or how to buy these charts, like please reach out, we'll connect you in with Nate, and if his story and the successes he's had resonate with you, email us, we'd love to chat with you. [email protected]. And Nate, thanks for being here today, thanks for just being a good human in this world. We need more people like you. So thanks for being here today.

0:40:27.0 DT: Thank you.

0:40:29.7 KD: Awesome, guys. Alright, as always, thank you all for listening, and I'll catch you next time on the Dental A-team podcast.

[music]

0:40:37.1 KD: And that wraps it up for another episode of the Dental A-team podcast. Thank you so much for listening and we'll talk to you next time.